Posts Tagged ‘insurance’

Many thanks to Regan Foster of The Pueblo Chieftain for so thoughtfully and skillfully presenting our ongoing struggle in trying to get Harrison some behavioral help. It is truly the story of a healthcare and mental-health system that is entirely broken and does not serve those in need.

Regan’s story will be Exhibit A for our appointment with an administrative law judge on March 21 to appeal a decision by the state to deny Harrison a Children’s Extended Services (CES) waiver for Medicaid. He was denied basically because his sleep habits, though not great, are not entirely horrible. Even if our appeal is upheld, the victory would be meaningless, as CES will not cover behavioral services beyond June.

Meanwhile, our insurance company, Cigna, after first denying that they cover ABA therapy in 2017 (and also erroneously denying we ever called), has changed its policy as of Jan. 1. Now they do “cover” behavioral therapy — with a $3,000 deductible and a 30 percent co-pay — which is the same as not having insurance at all except that we’re paying for this privilege.

As a side note it’s difficult for me to hear myself saying “But he’s never hurt anybody” when I know he left me with a nearly paralyzed arm and shoulder for about two months in 2013-14, and has nearly knocked me out with head-butts. I also have seen the bruises of others who love him, including Mary, and his teachers and aides, so I must have intended something else when I said that. Maybe he’s never “intentionally” hurt anybody would be more accurate.

Most of you know I’ve been writing extensively about this topic of autism parenting for years in my columns, blog, books and on Facebook, but it was fun to hand this ball off to Regan and see someone else’s perspective. GO READ it here.

I was in full agreement with the president during his health-care speech a few weeks ago until he got to the part when he said he didn’t want to put the insurance companies out of business.

Why not? They’ve been working to put us — individually and collectively — out of business for decades. Let some of these quasi Ponzi-schemers collect unemployment or stand in a soup line for a while. It’ll be cheaper in the long run.

Oddly, I find most people who are against some sort of public health system to be the same folks who already enjoy the benefits of the best socialized medicine programs in the world: Medicare, VA benefits, PERA, etc. Why shouldn’t the rest of us have the opportunity to buy into plans like these?

Here’s a little story for you . . . I carry what is known as “major medical” coverage with a $5,000 deductible for myself and my son. Besides being the type of coverage many of my doctor friends carry and recommend, it’s also what I can afford. Plus, I figure why give the insurance companies a lot of money when they are likely to deny any claim I have anyway. (“We’re sorry, Mr. Walter, we didn’t know that you . . . [fill in the blank: race pack burros, formerly worked in the newspaper business, ride saddle donkeys, run long distances, work around cattle, live in the same ecosystem with rattlesnakes, bears and mountain lions, have a rat terrier dog, drink water, breathe air, whatever]. We can’t possibly pay for your medical expenses. Perhaps the hospital would consider your home in partial trade for the amount due.”)

Or, just fill in a blank with “autism” and see what happens.

About a year-and-a-half ago we took Harrison to The Children’s Hospital in Denver to be tested for autism. The doctor told us right then and there he has autism, and we got out a credit card to pay for this testing ourselves, which is what we had intended to do from the very beginning without involving the insurance company.

A few weeks later we received via certified mail what amounted to an extortion letter from our insurance company alledging we had withheld a pre-existing condition — autism — when we signed up for our plan. The only remedy was a higher rate.

Huh? Check out the logic here. If we had known he had autism, then we would not be paying $2,500 out of our own pockets to find out he had it.

These greedheads aren’t just contemptible, they’re idiots.

Plus, here’s something else for you to think about. Why does my autistic son not deserve to have as good and as affordable coverage as anyone else? If anything, he should have better.

A new study published by the medical journal Pediatrics has found that autism is even more prevalent than previously believed. If this study is accurate, one in 92 children now have been diagnosed with autism, which translates to about 673,000 children in the United States.

Like the flu, statistics for autism also are compiled by the Centers for Disease Control, but is this condition really a disease? Can it be controlled? We don’t really know what it is or what causes it. We don’t know why some children are more affected than others. We don’t know why some apparently snap out of it at a certain age, while in others the problem progresses. We don’t know of any definitive treatment.

We really don’t know squat about autism, but we do know this: It’s a growing health-care issue and insurance companies don’t want to pay for it. Yet another reason we need to move beyond the corporate-greed model of health care and on to what we have already proven works — some sort of public health-care system.